Health Insurance

What qualifies me for health insurance eligibility?

You must be a permanent employee regularly scheduled to work a minimum of 15 hours per week.

Is health insurance coverage automatic?

No, COVERAGE IS NOT AUTOMATIC, you must enroll in this program. This is done by completing an enrollment form. An employee must elect coverage the first 31 days of employment, if coverage is declined at that time, an employee must wait until open enrollment unless there is a life-changing event, which would give the employee 31 days from the event to enroll.

Is enrolling in this health insurance plan MANDATORY?

No it is not.

Is there a cost to have this insurance?

Yes, there is a standard charge which will be deducted from you paycheck depending upon the coverage that you have selected. Montgomery County Government pays 85% of the monthly premium for a full-time employee and 75% of the premium for a part-time employee.The coverage options and rates for 2007-2008 are:

Full-Time (at least 30 hours per week)

Employee Pays Monthly

Individual = $362.84

$54.44

2-Party = $711.41

$106.72

Family = $851.82

$127.78

Part-Time (at least 15 hours per week)

Individual

$90.72

2-Party

$177.84

Family

$212.96

What is the Pre-tax contribution program?

Under this program, you may have your share of your health insurance premium deducted from your gross wages before taxes are withheld. This program may lower your taxes. However, if you pre-tax you are limited in the types of changes you can make to your plan outside of the annual open enrollment period, with the exception of a qualifying event such as marriage, birth of a child, adoption of a child, you have a change in job status that affects coverage, and death or divorce. When a qualifying event occurs, an employee has 31 days to make changes.

What is the NAME of my health insurance plan?

Clarksville-Montgomery County Employees Insurance Trust

What does my coverage include?

Major medical including hospitalization, surgical and prescription drug coverage.

What is the EFFECTIVE DATE of my insurance coverage?

Normally, the first of the month following two pay periods. Premiums are deducted one month in advance.

Can my dependents be covered on my plan?

Yes, eligible dependents include your spouse, unmarried, natural, legally adopted, or stepchild or children of the employee or employees’ spouse. The dependent child limiting age will be to age 19 or to age 25 if a full-time student or claimed as a dependent on the subscriber or subscriber’s spouse income tax return Dependent coverage will end on the last day of the month after reaching the dependent child limiting age.

Can I enroll or make changes in coverage at anytime?

No, changes are made during open enrollment or within 31 days of a life-changing event.

What is a deductible?

The amount of out of pocket expenses you must pay before your insurance will begin to pay. Currently our individual deductible is $300 and family deductible is $750 per calendar year. If a member has covered charges during the last three months of a calendar year which are applied to that year’s deductible, these charges will also be applied toward the deductible for the next year. The deductible will be waived for accidental injuries and generic medications.

What is co-pay?

A co-pay is the dollar amount for which a member is responsible when particular service or supply is received.

Your office visit co-pay will include any services performed in the doctor's office on the same date, including testing done in the office. If your physician sends you off-site for additional services, please refer to the enrollment packet for additional information.

What is a participating provider?

Participating providers are independent physicians who have agreed to participate with your plan. These preferred network providers have agreed to special pricing for patients with BlueCross BlueShield of Tennessee, which means lower out-of-pocket expenses for you. Our health plan is in the Blue Select Network. Please verify with your physicians’ office that they are a participating provider in the Blue Select Network.

What are usual, customary and reasonable (UCR) charges?

When electing to use non-participating providers for covered benefits, only usual, customary and reasonable charges are eligible for reimbursement and will be applied to your deductible. After the deductible is met, (paid in full), only UCR charges will be eligible for reimbursement by Blue Cross Blue Shield of Tennessee. You then will be responsible for any applicable coinsurance and charges that are in excess of UCR. UCR will vary by provider and service.

What are MC's wellness benefits?

Some examples of wellness benefits include routine physical exams, recommended adult and child immunizations, vision and hearing screenings performed by the physician during the preventive health exam, other prescribed x-ray, and laboratory screenings associated with preventive care.

How do I contact Member Services?

The number to Member Services is 1-800-558-6213, call between 8 a.m. – 5 p.m. EST, Monday through Friday.

What do I do if I need mental health or substance abuse care?

Magellan Health Services can supply information concerning the mental health and substance abuse benefit structure and details concerning available providers for this type care. The number to Magellan Health Services is 1-800-308-4934 or the web address is www.magellanhealth.com.

What if I am not sure if a service is covered?

If you are unsure about whether a procedure, type of facility, equipment, or any other expenses is covered by our medical plan contact Member Services at 1-800-558-6213 or ask your physician to submit a pre-determination request form describing the condition and treatment. The physician should send it to Blue Cross Blue S of Tennessee, Attention Provider Service Center 2 West, 801 Pine Street, Chattanooga, TN 37402. A response should be expected within 3 weeks.

What is a formulary?

A formulary is a list of prescription medications, which designates products which are approved for coverage by BCBST and which will be dispensed through participating pharmacies to members. This list is subject to periodic review and modification by BCBST.

What is the mail order feature of MC's prescription drug plan?

The mail order feature allows the employee to receive up to a three-month supply of prescription drugs. For individuals on maintenance drugs, this feature will add convenience and may save you time and money. For more information on taking advantage of mail service go to www.caremark.com or contact Human Resources at (931) 648-5715.

Can I be reimbursed through my medical spending account for any co-pay amounts?

Yes, you may set aside money in your medical spending account for reimbursement of co-pay amounts.

How can I tell what my co-pay will be for a specific drug?

Contact CVS Caremark Customer Care at 1-877-683-6837.

How do I use the mail-order prescription service?

Contact CVS Caremark Customer Care at 1-877-683-6837 or go to www.caremark.com, you can also request assistance from Human Resources.

What should I do if I am in an area where our network providers are not available and need health care services?

Call the BlueCard/Blue Card PPO Participating Doctor and Hospital Information Line at 1-800-810-BLUE (2583); you will be helped in locating the nearest BlueCard/BlueCard PPO Participating Physician or Hospital. Your benefits will be covered as in-network benefits.

What should I do if I travel out of the United States?

Through the BlueCard Worldwide Program, you have access to participating hospital network and referrals to doctors in major travel destinations throughout the world. When you need to locate a hospital or doctor, you can call the BlueCard Worldwide Service Center at 1 (800) 810-BLUE(2583) or call collect at 1 (804) 673-1177, 24 hours a day, 7 days a week. You can also visit the website https://international.worldaccess.com/bcbsa/index.asp?page=login

Can I use any local pharmacy?

You will need to verify that the pharmacy is in the Blue Select Network.

What should I do if my health insurance deduction from my paycheck is incorrect or not being deducted at all?

Your coverage will end approximately 30 days from the last day of the pay period in which you are being paid for. If you are leaving employment with Montgomery County Government you will receive information from Blue Cross Blue Shield about keeping your coverage under COBRA.

Dental Insurance

What is Dental Insurance?

An opportunity to help protect and care for your smile – and your family’s – at affordable group rates. You pay plan premiums through convenient payroll deductions. Preferred Dental Care Coverage is designed to promote cost-effective care and provide a simple method for filing claims.

Can I visit any dentist or specialist or only certain ones?

With the Blue Cross Blue Shield of Tennessee plan, you and your family members are free to visit any network or non-network dentist or specialist, any time you need care. However, when network dentists are used, you will usually spend less out of pocket. If you select a Dentist, who is not participating in the Preferred Dental Care Plan (an out-of network dentist) that dentist can bill you for any amount not covered by our Dental EOC. In addition, if you select an out-of network dentist, you must file the claim yourself. To reduce your out-of-pocket expense you should receive services from a network dentist.

Do all my covered family members have to go to the same network or non-network dentists?

No. In fact, every family member could go to a different network or non-network dentist or specialist, every time care is needed.

What types of dentists are considered specialists and do I need a referral to see one?

Specialists include endodontists, periodontists, prosthodontists, and oral and maxillofacial surgeons. No referral is needed in order to see a specialist. If either a network or non-network general practicing dentist suggests you see a specialist, they may recommend one to you – but you are always free to see any specialist you’d like, or choose one from your Blue Cross Blue Shield of Tennessee dental provider directory.

How can I find a network dentist or specialist near me?

You may either refer to your Blue Cross Blue Shield of Tennessee provider directory or locate a dentist on www.bcbst.com.

What is a plan deductible and/or annual maximum?

A deductible is the dollar amount of covered dental expenses you must pay during the year before Blue Cross Blue Shield of Tennessee pays benefits. An annual maximum is the maximum amount your dental plan will pay in benefits during the year. Both are generally based on the calendar year. Deductibles and annual maximums apply per covered person.

What is co-insurance?

For some service categories, you may share in the cost of your dental expenses. This is represented as a percentage of the negotiated fee for covered services. The percentage of co-insurance usually depends on the type of service received (preventive, basic, or major). Network services are typically reimbursed at a higher co-insurance percentage.

What is a negotiated fee-for-service?

This refers to the set maximum fees for services that have been negotiated with Blue Cross Blue Shield of Tennessee contracted network dentists and specialists. This averages 30% less than the fees they usually charge.

If I choose to visit a non-network dentist, will I spend more out-of-pocket?

Possibly. That is because when you or family member sees a non-network dentist; your non-network service charges will be paid for only up to the maximum fee level established with our contracted network dentists. Therefore, any amount above the maximum fee level is your responsibility. You may also have to pay a higher co-insurance level for non-network services.

When I visit a dentist, are there any claim forms to fill out?

Network dentists have contracted with Blue Cross Blue Shield of Tennessee to submit claim forms and accept benefits directly from Blue Cross Blue Shield of Tennessee. Some non-network dentists may submit claims directly to Blue Cross Blue Shield of Tennessee. More often, however, non-network dentists will require that you pay for services at the time they are rendered. Afterward, complete a simple claim form and forward it to Blue Cross Blue Shield of Tennessee along with a copy of your payment receipts.

What are the benefits or our dental plan?

Covered Service

Coinsurance Percentages

Benefit Maximum

Diagnostic and Preventative Services(Coverage A)

100%

Restorative Services(Coverage B)

80%

$1500 per calendar year

Prosthetic and Complex Restorative Services(Coverage C)

50%

Orthodontic Services

50%

$1500 per lifetime

What is our deductible?

There is a $50 deductible that applies to Restorative Services (coverage B), and Prosthetic, and Complex Restorative Services (coverage C).

Payroll Information

When will I receive my first paycheck?

Montgomery County pays on a 2 week lag basis, therefore you will need to complete your first 2 weeks of employment and you will receive your paycheck two weeks after that.

What is deducted from my wages?

All required deductions, such as Federal taxes, any authorized voluntary deductions, such health co-pays, and retirement savings plan contributions, will be withheld automatically from your paychecks.

Why must I have my check direct deposited?

To ensure you receive your paycheck correctly and on a timely basis, Montgomery County Government requires you to have your payroll checks directly deposited into your bank account.

How does direct deposit work?

You will have your check direct deposited to any financial institution that receives and participates in EFT (Electronic Funds Transfer) program. You designate the account(s) you wish to have your paycheck sent to electronically, and the funds are available to you on the morning of payday.

Will my first paycheck be direct deposit?

No, your first check will be a live check and you will need to deposit it into your account. In order to ensure that we have your correct information, we will run a pre-note.

If I use direct deposit, how will I know how much my check is?

You will receive a deposit advice (pay stub) detailing your paycheck.

Where do I receive my direct deposit advices?

Direct deposit advices are picked up by your department and are generally distributed by a designated individual in your department. Check with your department for specifics.

I did not receive my first check on the date I had expected, what should I do?

There may be several different explanations, you should contact Robyn Bryant in Human Resources at 648-5715, extension 7223 or e-mail rmbryant@montgomerycountytn.org.

When will I receive my final paycheck?

You should receive your final paycheck approximately two weeks after your last day of employment.

Tennessee Retirement System and Supplemental Retirement Options

When am I eligible to join a retirement system?

As an employee of Montgomery County Government, you become eligible to join the Tennessee Consolidated Retirement System, www.treasury.state.tn.us/tcrs following the completion of six months of employment. This is not an optional benefit for you.

Would I need to make a contribution to this plan?

No, this plan is provided to you at no cost.

What if I am already a member of a Tennessee Retirement System?

If you are already a member, you must provide this information to them.

What is a supplemental retirement account?

This is an additional retirement savings/investment plan used to supplemental your other retirement benefits.

Do I make a contribution to this plan?

Yes, this plan is funded by tax-deferred contributions from your paycheck. There are no employer contributions made to this type of a tax deferred plan. You may start, stop, or change your contributions at any time.

What do I need to do if I would like additional information or if I would like to participate in this plan?

Further information can be obtained from The Principal (www.principal.com) or the Human Resources Office (931) 648-5712, extension 7215, e-mail drmoore@montgomerycountytn.org or stop by the Human Resources office, Monday – Friday 7:30 a.m.-4 p.m. An application form is required.

Montgomery County Government complies with the following Civil Rights statutes;
Titles VI, VII, and IX of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973,
Americans with Disabilities Act and the Age Discrimination Act of 1975.